The effects of pulmonary rehabilitation with chronic obstructive pulmonary disease (COPD)]

It is controversial whether pulmonary rehabilitation is effective in patients with chronic obstructive pulmonary disease (COPD). To test the effect of pulmonary rehabilitation, 7 patients with COPD (aged 76.0 +/- 2.6 years) were enrolled in pulmonary rehabilitation program for 6 weeks. The program consisted of relaxation, pursed lip breathing, diaphragmatic breathing, panic control, muscle stretch gymnastics, and exercise training. The distance of the 6-minute walking test increased significantly from 246.4 +/- 38.0 (m) to 304.3 +/- 28.4 (m) (p < 0.05). The minimum SpO2 during the 6-minute walking test increased from 86.0 +/- 2.8 (%) to 90.1 +/- 1.3 (%) and dyspnea as measured with Borg scale decreased from 5.6 +/- 1.1 to 4.6 +/- 0.5, although they were not significantly different. These results suggest that pulmonary rehabilitation might improve exercise tolerance in elderly patients with COPD.     

The effects of helium-hyperoxia on 6-min walking distance in COPD: a randomized, controlled trial

BACKGROUND: We hypothesized that breathing helium-hyperoxia (HeO2) would significantly improve 6-min walking test (6MWT) distance in COPD subjects. METHODS: This was a blinded, randomized crossover study. At visit 1, we assessed pulmonary function, exercise capacity, and 6MWT distance. Visits 2 and 3 consisted of four 6MWTs in which the following different inspired gases were used: room air (RA) by mask; 100% O2 by mask (mask O2); 100% O2 by nasal prongs (nasal O2); and 70% He/30% O2 by mask (HeO2). Walking distance, shortness of breath, leg fatigue, O2 saturation, and heart rate (HR) were assessed. RESULTS: Sixteen COPD subjects participated (mean FEV(1)/FVC ratio [+/- SD], 48 +/- 8%; mean FEV1, 55 +/- 13% predicted). Subjects walked farther when breathing HeO2 (564 m) compared to RA (497 m; p < 0.001), mask O2 (520 m; p < 0.001), or nasal O2 (528 m; p < 0.001). Despite the increased distance walked while breathing HeO2, there was no increase in shortness of breath or leg fatigue. There was desaturation when breathing RA (8%; p < 0.001) and nasal O2 (5%; p < 0.001), which was reduced when breathing HeO2 (3%; difference not significant) and mask O(2) (0%; difference not significant). There were no significant differences in HR in the four 6MWTs. CONCLUSIONS: The use of HeO2 increased 6MWT distance in COPD subjects more than either mask O2 or nasal O2 compared to RA. The increased walking distance was not associated with increased shortness of breath or leg fatigue. The results suggest that clinical benefit would be obtained by administering HeO2 during exercise, which may have significant clinical implications for the management of COPD patients.     

Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial

PURPOSE: Pulmonary rehabilitation programs are effective in patients with severe chronic obstructive pulmonary disease (COPD) in the short term, but their long-term effects are not known. We investigated the short- and long-term effects of a 6-month outpatient rehabilitation program in patients with severe COPD. SUBJECTS AND METHODS: One hundred patients were randomly assigned to receive either an exercise training program that included cycling, walking, and strength training (n = 50) or usual medical care (n = 50). Thirty-four patients in the training group were evaluated after 6 months (end of training), and 26 were evaluated after 18 months of follow-up. In the control group, 28 patients were evaluated at 6 months and 23 after 18 months. We measured pulmonary function, 6-minute walking distance, maximal exercise capacity, peripheral and respiratory muscle strength, and quality of life (on a 20 to 140-point scale), and estimated the cost-effectiveness of the program. RESULTS: At 6 months, the training group showed improvement in 6-minute walking distance [mean difference (training - control) of 52 m; 95% confidence interval (CI), 15 to 89 m], maximal work load (12 W; 95% CI, 6 to 19 W), maximal oxygen uptake (0.26 liters/min; 95% CI, 0.07 to 0.45 liters/min), quadriceps force (18 Nm; 95% CI, 7 to 29 Nm), inspiratory muscle force (11 cm H(2)O; 95% CI, 3 to 20 cm H(2)O), and quality of life (14 points; 95% CI, 6 to 21 points; all P <0.05). At 18 months all these differences persisted (P <0.05), except for inspiratory muscle strength. For 6-minute walking distance and quality of life, the differences between the training group and controls at 18 months exceeded the minimal clinically-important difference. CONCLUSION: Among patients who completed the 6-month program, outpatient training resulted in significant and clinically relevant changes in 6-minute walking distance, maximal exercise performance, peripheral and respiratory muscle strength, and quality of life. Most of these effects persisted 18 months after starting the program.     

Effects of pulmonary rehabilitation in patients with pulmonary tuberculosis sequelae]

Pulmonary rehabilitation was evaluated for a mean period of 3.9 weeks in 37 inpatients with pulmonary tuberculosis sequelae. The rehabilitation program consisted of relaxation, breathing retraining, exercise training, respiratory muscle training and instruction. Significant improvement was shown in VC (n = 37) on average from 1.48 l to 1.59 l, in FEV1.0 (n = 37) from 0.93 l to 1.02 l, in PaO2 (n = 35) from 67.1 Torr to 72.4 Torr, in 6-minute walking distance (n = 29) from 303 m to 339 m, in Pimax (n = 17) from 38.5 cmH2O to 47.5 cmH2O, in activity (n = 23) from 19.6 points to 22.5 points, in dyspnea (n = 22) from 18.4 points to 22.5 points and in QOL (n = 25) from 39.0 points to 44.2 points. The effects of pulmonary rehabilitation did not depend on past thoracic surgery for tuberculosis, pattern of ventilatory impairment, findings of chest radiography, or degree of insufficiency. These data suggest that pulmonary rehabilitation is of benefit for improving pulmonary function, exercise tolerance, symptoms and QOL in patients with pulmonary tuberculosis sequelae.     

A comparison of autogenic drainage and the active cycle of breathing techniques in patients with chronic obstructive pulmonary diseases

PURPOSE: The effects of a long-term treatment of autogenic drainage (AD) and the active cycle of breathing techniques (ACBT) were evaluated in patients with chronic obstructive pulmonary disease (COPD). METHODS: Thirty clinically stable male COPD patients were randomly assigned to AD or the ACBT treatment for a 20-day treatment period. Patients were assessed through pulmonary function tests, arterial blood gases, a 6-minute walking test, and a modified Borg Scale before, and immediately after the walking test. RESULTS: Autogenic drainage improved forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow rate, forced expiratory volume from 25 to 75%, chronic hypercapnia, arterial oxygenation, exercise performance, and dyspnea perception during exercise. The ACBT increased forced vital capacity, peak expiratory flow rate, arterial oxygenation and exercise performance. Peak expiratory flow rate increased in AD more than in ACBT. In AD treatment, the increase in oxygen saturation was significantly higher than in ACBT treatment. Chronic hypercapnia improved significantly in AD treatment than in ACBT. No differences were found in other lung function parameters. CONCLUSIONS: Autogenic drainage is as effective as the ACBT in cleaning secretions and improving lung functions. These techniques can be used in stable COPD patients according to the patients' and the physiotherapists' preferences.     

家庭无创正压机械通气联合呼吸操对稳定期慢性阻塞性肺疾病患者的随机对照研究

目的 探索与评估家庭无创正压机械通气(HNPPV)联合呼吸操对稳定期重度慢性阻塞性肺疾病(COPD)患者的疗效.方法 将56例经住院治疗处于稳定期的重度COPD患者分为呼吸操+HNPPV组(治疗组)26例和无创呼吸机组(对照组)30例.分别记录治疗前、治疗后2年两组患者的动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、肺功能、6分钟行走距离(6MWD)、呼吸困难分级、辅助呼吸肌评分、年住院次数及病死率等指标.结果 治疗前治疗组与对照组的年龄、性别、COPD病程、体质量指数、PaCO2、PaO2、第1秒用力呼气容积占预计值百分比(FEV1%pred)、第1秒用力呼气容积占用力肺活量比值(FEV1/FVC%)、6MWD、呼吸困难分级、辅助呼吸肌评分、每年住院次数均具有可比性.2年后治疗组呼吸困难分级、辅助呼吸肌评分、6MWD、每年住院次数,优于对照组[(1.76±0.52)分vs(2.09±0.57)分、(2.44±0.62)分vs(2.96±0.58)分、(262.64±32.98)m vs(244.25±25.83)m、(2.06±0.85)次/年vs(2.62±0.92)次/年],差异均具有统计学意义(P值均＜0.05),治疗组死亡1例(1/26),对照组死亡2例(2/30),两组病死率比较差异无统计学意义(x2=0.02).结论 长期应用HNPPV联合呼吸操锻炼对稳定期重度COPD患者的康复更加有效.     

慢性阻塞性肺疾病2种肺康复策略的疗效比较

目的:比较2种不同的肺康复干预策略对慢性阻塞性肺疾病(COPD)患者BODE指数评分、焦虑抑郁及日常生活活动能力的改善及脱落率。方法:采用随机、对照的方法将155例稳定期COPD患者分为3组,肺康复干预Ⅰ组给予康复宣教、有氧呼吸操及体能训练;肺康复干预Ⅱ组仅给予康复宣教及有氧呼吸操,对照组不给予肺康复干预,为期20周。比较康复前后3组患者BODE指数、焦虑抑郁及日常生活活动能力评分及脱落的差异。结果:经过20周的肺康复干预,肺康复干预Ⅰ、Ⅱ组较对照组在焦虑抑郁评分、6 min步行距离、呼吸困难程度评分均明显改善(P<0.01),但脱落率明显高于其他2组(P     

Sildenafil for long-term treatment of nonoperable chronic thromboembolic pulmonary hypertension

Only a small percentage of patients with chronic thromboembolic pulmonary hypertension are eligible for pulmonary thrombendarterectomy. We investigated the effects of oral sildenafil on hemodynamics and exercise capacity in 12 nonoperable chronic thromboembolic pulmonary hypertension patients. All patients were in disease progression despite sufficient long-term anticoagulation and the best supportive care and suffered from severe pulmonary hypertension (pulmonary vascular resistance index 1,935 +/- 228 dyn. s. cm-5. m2, cardiac index 2.0 l. min-1. m-2, 6-minute walking distance 312 +/- 30 m). After approximately 6 months of sildenafil treatment, pulmonary hemodynamics and exercise capacity improved significantly (pulmonary vascular resistance index 1,361 +/- 177 L. min-1. m2, p = 0.004, cardiac index 2.4 +/- 0.2 L. min-1. m-2, p = 0.009, 6-minute walking distance 366 +/- 28 m, p = 0.02). Therefore, oral sildenafil may offer a new option for medical treatment of this devastating disease.     

Influence of inhaled procaterol on pulmonary rehabilitation in chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive condition that classically causes dyspnea during physical activity. Destruction of alveoli and bronchostenosis are thought to lead to shortness of breath and result in decreased physical activity. In this study, we examined the influence of inhaled procaterol on exercise therapy for pulmonary rehabilitation.MethodsPatients with moderate to severe stable COPD were randomly divided into 2 groups those who inhaled procaterol before exercise (n=10) and those who did not (control group) (n=11). For 12 weeks, all patients performed their pulmonary rehabilitation exercises at home. We measured the 6-minute walking distance (6MWD) to assess exercise tolerance and used St. George's respiratory questionnaire (SGRQ) to assess health-related quality of life (HRQOL) before and after the 12-week exercise program.ResultsCompared to the control group, the group receiving inhaled procaterol showed significant improvement of 6MWD and SGRQ scores.ConclusionOur data suggest that a pulmonary rehabilitation program combined with inhaled procaterol can improve both HRQOL and exercise tolerance in COPD patients.     

Effect of pulmonary rehabilitation on quality of life in patients with COPD: the use of SF-36 summary scores as outcomes measures

PURPOSE: Pulmonary rehabilitation (PR) is an accepted therapy for patients with chronic obstructive pulmonary disease (COPD), improving both exercise capacity and quality of life (QOL). Generic measures of QOL have been criticized as being insensitive to detecting the improvement in QOL after PR in contrast to disease-specific instruments. The authors looked at the Medical Outcomes Survey Short Form 36-item questionnaire (SF-36), a generic QOL measure, to detect changes in QOL in COPD patients after completion of PR. METHODS: Patients with COPD who participated in a PR program completed the QOL questionnaire before and after completion of PR. Exercise tolerance was assessed by the 6-minute walking test. Quality of life was assessed by the SF-36; the authors calculated its eight dimensions as well as mental (MCS) and physical (PCS) component summary scores. RESULTS: The patients realized a significant improvement in exercise tolerance; 6-minute walking test distance increased from 470 +/- 104 m (mean +/- standard deviation) to 536 +/- 133 m (P = 0.0006) after PR. Quality of life also improved in nearly all dimensions and in both summary scores; PCS improved from 26.1 +/- 8.0 before PR to 30.5 +/- 9.0 after PR (P = 0.008) and MCS improved from 27.9 +/- 7.0 before PR to 34.1 +/- 5.0 after PR (P = 0.0002). CONCLUSION: The SF-36 and its summary scores are sensitive instruments to detect improvement in QOL in COPD patients after PR.     

The effect of helium and oxygen on exercise performance in chronic obstructive pulmonary disease: a randomized crossover trial

RATIONALE: Breathing supplemental oxygen reduces breathlessness during exercise in patients with chronic obstructive pulmonary disease (COPD). Replacing nitrogen with helium reduces expiratory flow resistance and may improve lung emptying. Combining these treatments should be independently effective. OBJECTIVES: Study the effect of changing oxygen or helium concentration in inspired gas during exercise in patients with stable COPD. METHODS: In 82 patients (mean age, 69.7 yr; mean FEV(1), 42.6% predicted), we measured endurance shuttle walking distance, resting and exercise oxygen saturation, and end-exercise dyspnea (Borg scale) while patients breathed Heliox28 (72% He/28% O(2)), Heliox21 (79% He/21% O(2)), Oxygen28 (72% N(2)/28% O(2)), or medical air (79% N(2)/21% O(2)). Gases were administered using a randomized, blinded, crossover design via a face mask and an inspiratory demand valve. RESULTS: Breathing Heliox28 increased walking distance (mean+/-SD, 147+/-150 m) and reduced Borg score (-1.28+/-1.30) more than any other gas mixture. Heliox21 significantly increased walking distance (99+/-101 m) and reduced dyspnea (Borg score, -0.76+/-0.77) compared with medical air. These changes were similar to those breathing Oxygen28. The effects of helium and oxygen in Heliox28 were independent. The increase in walking distance while breathing Heliox28 was inversely related to baseline FEV(1) breathing air. Conclusion: Reducing inspired gas density can improve exercise performance in COPD as much as increasing inspired oxygen. These effects can be combined as Heliox28 and are most evident in patients with more severe airflow obstruction.     

肺康复治疗对稳定期慢性阻塞性肺疾病病人的疗效分析

目的观察肺康复治疗对稳定期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者的效果。方法测定以下肢训练为主的社区康复治疗前后患者的FEV1(第一秒用力呼气量占预计值百分比)、6 min步行距离、呼吸困难评分(Borg评分)、年人均急性发作次数、年人均住院次数。结果肺康复治疗前后的FEV1、6 min步行距离、Borg评分明显好于治疗前(P0.05),年COPD急性发作次数及住院次数治疗前后有统计学意义。结论肺康复治疗可改善COPD患者的呼吸功能,减少年均急性发作次数及住院次数。     

The functional impact of an individualized, graded, outpatient pulmonary rehabilitation in end-stage chronic obstructive pulmonary disease

OBJECTIVE: To evaluate the functional impact of an individualized outpatient pulmonary rehabilitation program in end-stage chronic obstructive pulmonary disease (COPD). METHODS: Patients with end-stage COPD were admitted into a 6-week comprehensive outpatient pulmonary rehabilitation program that was "packaged" for each patient. We compared spirometric parameters, exercise tolerance, level of breathlessness, and intensity of work before and after rehabilitation. RESULTS: Of 45 eligible patients, only 14 consented to participate in the study. All 14 patients had forced expiratory volume in 1 second <35% of predicted, and 10 patients (72%) had a 6-minute walk test <180 m. The level of breathlessness was between 7 (moderate to severely breathless) and 10 (maximally breathless) on the Visual Analogue Scale in all patients. After the program, there was significant improvement in the FEV 1 P = 0.04), forced vital capacity P = 0.0045), 6-minute walk test P = 0.00047), and shuttle-walk test (9 of 14 patients). All patients had some improvement in level of dyspnea. CONCLUSIONS: Individualized outpatient pulmonary rehabilitation in end-stage COPD can produce a measurable improvement in spirometry and exercise tolerance with a favorable impact on the level of physical activity.     

肺功能状态和呼吸困难问卷用于慢性阻塞性肺疾病患者的信度与效度研究

目的 评价中文版肺功能状态和呼吸困难问卷(PFSDQ)修订版用于COPD患者的信度和效度.方法 于2009年4-9月在北京市2家医院呼吸科门诊选取COPD稳定期患者61例,其中男52例,女9例;年龄51～80岁,平均(66±7)岁.用PFSDQ修订版和修订的英国医学委员会呼吸困难量表(MMRC量表)评估其呼吸困难及功能情况,并于同日或1周内进行检测肺功能和6 min步行试验.PFSDQ修订版包括活动受限程度、活动后呼吸困难和活动后疲乏3个维度.结果 PFSDQ修订版中活动受限、活动后呼吸困难和活动后疲乏3个维度的克龙巴赫α系数分别为0.84、0.85和0.89,与6 min步行距离、FEV_1、FEV_1/FVC、FEV_1占预计值%、MMRC测评的呼吸困难程度和BODE指数均有显著相关性(r值为-0.27～0.66,均P＜0.01).上述3个维度在病情严重程度不同的患者中进行两两比较,差异均有统计学意义(χ~2值为7.35～15.21,P＜0.05和P＜0.01).结论 中文版PFSDQ修订版在61例COPD患者中使用具有良好的信度和效度,适用于我国COPD患者.     

Effects of supplemental oxygen during activity in patients with advanced COPD without severe resting hypoxemia

STUDY OBJECTIVES: To assess oxygen desaturation during activities and to evaluate the short-term effects of supplemental O(2) use in patients with severe COPD who do not qualify for long-term O(2) therapy. DESIGN: A double-blind, randomized, placebo-controlled trial. SETTING: Outpatients from the pulmonary diseases division of a tertiary-care university hospital. PATIENTS: Twenty patients with stable COPD with FEV(1)/FVC ratios of < 50%, FEV(1) levels < 55% of the predicted normal value, and PaO(2) levels of > 60 mm Hg when resting. INTERVENTIONS: Patients were initially evaluated with pulmonary function tests, blood gas analysis, and Doppler echocardiography, and they underwent the following three 6-min walking tests (WTs) in a random sequence: basal WT (BWT); WT while breathing compressed air (CAWT); and WT while breathing O(2) (O(2)WT). Measurements and results: The distance walked was recorded in meters. Dyspnea was measured by Borg scale measurement before and after the tests, and arterial oxygen saturation measured by pulse oximetry (SpO(2)) was continuously monitored. Results were analyzed by grouping patients in the following manner: desaturators (DSs) (ie, patients with a drop in SpO(2) of at least 5% and < 90% during the WT) vs nondesaturators (NDSs); and O(2) responders (ie, patients with an increase of at least 10% in the distance walked and/or a decrease of at least 3 points in Borg index score) vs nonresponders. During the BWT, 11 of 20 patients (55%) were defined as desaturators. During the O(2)WT, the SpO(2) remained at > 90% in every patient. The distance walked increased by 22% (p < 0.02), and dyspnea decreased 36% (p < 0.01) in DS patients. In NDS patients, O(2) administration reduced dyspnea by 47% (p < 0.001), but the distance walked did not improve. Responses were markedly different from one patient to another. No significant differences were noticed between the results of the BWT and CAWT in any of the groups. Thirteen O(2) responders did not differ from 7 nonresponders either in basal data or in desaturation measure during the BWT, except that all walking responders (five patients) were above the median of basal left ventricle performance. CONCLUSIONS: Most of the studied COPD patients desaturated during the BWT. O(2) administration avoided desaturation and could increase the distance walked and reduce dyspnea, but these effects were not related to walking desaturation in individual cases. Improvements were not a placebo effect. The therapeutic role of O(2) during activities in some patients with severe COPD needs to be individually assessed.     

Managing chronic obstructive pulmonary disease in the community. A randomized controlled trial of home-based pulmonary rehabilitation for elderly housebound patients

PURPOSE: Pulmonary rehabilitation is essential for managing chronic obstructive pulmonary disease (COPD). Housebound COPD patients are frequently excluded from this treatment because they are unable to access outpatient pulmonary rehabilitation programs because of the severity of their disease. This randomized controlled trial assesses the effects of a 12-week home-based pulmonary rehabilitation program for 60 housebound COPD patients older than 60 years. METHODS: Intervention patients received an individually tailored supervised walking and arm exercise program as well as individual multidisciplinary education sessions on COPD and its management. Outcomes were assessed using the 6-minute walk test, St George's respiratory questionnaire, and Borg score of perceived breathlessness. Healthcare utilization was assessed using hospital admission rates with exacerbation of COPD and average length of stay at readmission. RESULTS: Complete data for 23 patients in each group were available for analysis. There was no significant difference between groups on baseline measures. Compared with the control group, intervention patients demonstrated a significant improvement in 6-minute walk test (P = .023), Borg score of perceived breathlessness (P = .024), St George's respiratory questionnaire total score (P = .020), and impact subscore (P = .024). At 6 months, the intervention group had a significantly shorter average length of stay at readmission to hospital with exacerbation (P = .035). CONCLUSION: A 12-week home-based pulmonary rehabilitation is effective in improving exercise tolerance, perception of breathlessness, and quality of life for housebound COPD patients. To manage COPD in the community more effectively, health services should focus on expanding home-based pulmonary rehabilitation.     

Sleep disordered breathing in patients with chronic obstructive pulmonary disease

Sleep-related disordered breathing (SDB) and its influence on desaturation were examined in stable COPD patients with waking SpO2 > 90%. With respiratory inductance plethysmography, thoracic-abdominal respiratory movements for all events with more than 4% desaturation were analyzed in 26 patients. Types of SDB were confirmed by full polysomnography. Irregular breathing induced desaturation, while stable respiration continued during some desaturation events. Three types of altered ventilation were observed: hypoventilation, paradoxical movement and periodic breathing. An unusual type of paradoxical movement, with normal airflow despite progressive desaturation, was observed in REM sleep. Patients were divided into desaturation (15 patients) and non-desaturation (11 patients) groups. Daytime arterial blood gas, lung function values, and 6-min walking distance did not differ. Awake, mode, maximum and minimum nocturnal SpO2 were lower in the desaturation group. SDB-induced desaturation events in the desaturation group were more frequent (9.2+/-3.5 vs. 1.8+/-2.2 times), a greater SpO2 decrease (11.4+/-7.1% vs. 5.2+/-2.1%) and longer duration (73.2+/-34.8 vs. 18.8+/-39.0 min). Patterns of SDB in the desaturation group were hypoventilation (74.4+/-23.4%), paradoxical movement (10.2+/-14.5%), periodic breathing (12.1+/-18.3%) and unclassified (5.8+/-11.2%). These results reveal that lower SpO2 and SDB influence nocturnal desaturation in stable COPD patients.     

Home respiratory muscle training in patients with chronic obstructive pulmonary disease

OBJECTIVE AND BACKGROUND: The benefits of inspiratory muscle strength training in decreasing symptoms, disability or handicap of patients affected by COPD are not well established. The objective of this study was to assess the efficacy of the constant use of a new flow-volumetric inspiratory exerciser, named Respivol, in improving respiratory functional parameters in COPD patients. METHODS: Twenty consecutive ambulatory patients affected by COPD were enrolled. Each patient was assessed, before and after 3 and 6 months inspiratory exercise with Respivol, for the following clinical parameters: maximal inspiratory pressure, maximal expiratory pressure, dyspnoea grade, quality of life by a self-administered St George questionnaire and a 6-min walking test. After a brief progressive ambulatory training programme, inspiratory exercise with Respivol was performed at home for 6 months. All patients used Respivol together with medical treatment. RESULTS: Maximal inspiratory pressure and maximal expiratory pressure values were significantly increased after 3 and 6 months of exercise. Dyspnoea grade was significantly reduced and the 6-min walking test showed an increase in effort tolerance, after 6 months of home training. Quality of life assessment showed an improvement, associated with a decrease of respiratory disease symptoms. CONCLUSIONS: Inspiratory muscle strength training with Respivol seems to be efficient in reducing symptoms and improving quality of life in adults with COPD.     

Noninvasive ventilation acutely modifies heart rate variability in chronic obstructive pulmonary disease patients

OBJECTIVE: The purpose of present study was to evaluate the acute effects of bi-level positive airway pressure (BiPAP) on heart rate variability (HRV) of stable chronic obstructive pulmonary disease patients (COPD). METHODS: Nineteen males with COPD (69+/-8 years and with forced expiratory volume in 1s <50% of predicted) and eight healthy sedentary age-matched (69 years) males in the control group (CG) were evaluated during two conditions of controlled respiratory rate: spontaneous breathing (SB) and BiPAP (inspiratory and expiratory levels between 12-14 cmH(2)O and 4-6 cmH(2)O, respectively). Peripheral oxygen saturation (SpO(2)), end-tidal of carbon dioxide (ETCO(2)), systolic blood pressure (SBP) and R-R interval were obtained. HRV was analyzed by time (RMSSD and SDNN index) and frequency domains (high frequency - HF, low frequency - LF and HF/LF ratio). RESULTS: Significant reduction of ETCO(2) and SBP in both groups and increase of SpO(2) in COPD group was observed during BiPAP ventilation (p<0.05). During spontaneous breathing, patients with COPD presented lower values of LF, LF/HF and higher values of HF when compared to CG (p<0.05). However, HF was significantly reduced and LF increased during BiPAP ventilation (58+/-19-48+/-15 and 41+/-19-52+/-15 un, respectively) in COPD group. Significant correlations between delta BiPAP-SB (Delta) ETCO(2) and DeltaHF were found (r=0.89). CONCLUSIONS: Sympathetic and parasympathetic neural control of heart rate is altered in COPD patients and that BiPAP acutely improves ventilation, enhances sympathetic response and decreases vagal tonus. The improvement of ventilation caused by BiPAP was associated with reduced cardiac vagal activity in stable moderate-to-severe COPD patients.     

The effects of pulmonary rehabilitation in elderly patients]

Pulmonary rehabilitation is one of the most important treatment modalities for patients with chronic lung disease. To determine the effects of an outpatient pulmonary rehabilitation program for the older members (aged 77 +/- 3 years; seniors) of an elderly patient group with chronic lung disease, we prospectively compared the degrees of improvement of lung function, dyspnea, daily activities and exercise tolerance (6-minute walking distance) after a 9-week rehabilitation program in 27 seniors with chronic lung disease (COPD 18, post-tuberculosis lung disorders 8, lung fibrosis 1; %FEV1 50.9 +/- 17.1%) with that in disease- and %FEV1-matched younger members (aged 70 +/- 2 years; juniors; %FEV1 49.3 +/- 16.1%) of the elderly patient group. All patients performed supervised weekly outpatient exercise and education activities for 9 weeks and a home exercise regimen. Assessments were made before and after the program. Twenty-three of the seniors and 25 of the juniors completed the program. There was no significant difference in the withdrawal rates between these groups. Although lung function and blood gas data had not changed significantly after rehabilitation, the clinical symptoms and the 6-minute walking exercise improved significantly in both groups (Baseline Dyspnea Index focal score: +1.3 +/- 0.9 in the seniors and +0.6 +/- 0.9 in the juniors: 6-minute walking distance: +/- 52 m and +/- 62 m, respectively) and the improvement of the Baseline Dyspnea Index focal score was significantly greater in the seniors than in the juniors. We observed the patients after they had followed the program for 2,000 days and found that the continuation ratio of rehabilitation in the seniors was far inferior to that in the juniors (continuation ratios for 1.2 and 3 years in the seniors were 50.5, 18.0 and 0%, respectively, and in the juniors, 79.5, 66.2 and 61.5%). We concluded that, although the senior elderly patients could benefit from the pulmonary rehabilitation program, it is difficult to maintain this benefit for many years.